Essential Newborn Care Protocol

Immediate newborn care

 Time band: at perineal bulging
 Intervention: prepare for the delivery
 Action:
 Ensure that the delivery area is draft-free and between 25-28⁰C
using room thermometer
 Wash hands with clean water and soap
 Double glove just before delivery
Immediate Newborn Care
(First 90 minutes)
 Time band: First 30 seconds (call out time of birth)
 Intervention: dry and provide warmth
 Action:
 Use clean, dry cloth to thoroughly dry the baby by wiping the eyes,
face, head, front and back, arms and legs
 Remove the wet cloth
 Do a quick check of baby’s breathing while drying

Note:
Do not ventilate unless baby is floppy/limp/not breathing
Do not suction unless the mouth/nose are blocked with
secretions or other material
Immediate Newborn Care
(First 90 minutes)
• Time band: if after first 30 seconds of drying, baby is
limp/floppy/not breathing
• Intervention: Re-position, suction and ventilate
• Action:
• Clamp and cut cord immediately
• Call for help
• Transfer to warm, firm surface
• Inform parents that baby has difficulty breathing and you will help the
baby to breathe
• Start resuscitation protocol
Notes for baby who is floppy/limp/not
breathing
 Health worker not skilled at advanced resuscitation (or
skilled but not equipped with intubation needs):
 Clear the mouth
 Start bag/mask ventilation
 Refer and transport
 Health worker with advanced skills at resuscitation:
 Intubate the baby and ventilate
 Refer and transport as necessary
Immediate Newborn Care
(First 90 minutes)
• Time band: if after 30 seconds of drying the baby is breathing
or crying
• Intervention: Do skin-to-skin contact
• Action:
• Avoid any manipulation (such as routine suctioning) that may cause
trauma or introduce infection
 Place baby prone in skin-to-skin contact on mother’s abdomen
 Cover baby’s back with a blanket and head with a bonnet
 Place identification band on ankle
Notes for the baby who is breathing/crying
 Do not separate the baby from the mother as long as the
baby does not exhibit severe chest in-drawing, gasping or
apnea and the mother does not need urgent medical
stabilization (e.g. hysterectomy)
 Do not put the baby on a cold or wet surface
 Do not wipe off the vernix
 Do not bathe the baby earlier than 6 hours of life
 Do not do footprinting
Within first 90 minutes of life
 Time band: 1-3 minutes
 Intervention: delayed or non-immediate cord clamping
 Action:
 Remove first set of gloves immediately prior to cord clamping
 Clamp and cut the cord after cord pulsations have stopped
 Put ties around the cord at 2cm and 5cm from the baby’s abdomen
 Cut between ties using sterile instrument
 Observe for oozing of blood

Note:
Do not milk the cord towards the newborn
After cord clamping, ensure 10IU oxytocin IM is given to the mother
Within first 90 minutes of life
 Time band: within 90 minutes of age
 Intervention: Provide support for initiation of
breastfeeding
 Action:
 Remove the first set of gloves immediately prior to cord
clamping
 Leave the baby on mother’s chest in SSC
 Observe the baby. Only when the newborn shows feeding cues
(opening of mouth, tounging, licking, rooting), make verbal
suggestions to the mother to nudge her baby to move to the
breast
 Counsel on positioning and attachment: when the bay is
ready, advise the mother to:
 Make sure the baby’s neck is not flexed or twisted
 Make sure the baby is facing the breast, with the baby’s nose
opposite her nipple and chin touching the breast
 Hold newborn’s body close to her body
 Support the baby’s whole body, not just the neck and shoulders
 Wait until her newborn’s mouth is opened wide
 Move her newborn onto her breast, aiming the infant’s lower
lip well below the nipple
Summary of interventions after drying the
baby and placing baby in SSC
 Do delayed or non-immediate cord clamping
 Remove 1st set of gloves immediately prior to cord clamping
 Place ties around 2cm and 5cm from baby’s abdomen
 Oxytocin 10 IU IM to mother after cord clamping
 Provide support for initiation of breastfeeding
 Provide additional care for a small baby or twin (KMC)
 Prepare very small baby (<1.5kg) or a baby born >2 months early
for referral
 Do eye care
 Administer erythromycin/tetracycline/2.5% povidone-iodine after
baby has located the breast
After first 90 minutes
 Does the baby have signs of illness?
 Is the baby visibly small?
 Keep baby in SSC; cover with extra blankets; prepare for
referral if <1.5kg
 After 90 minutes of age (after baby has detached from
breast):
 Examine baby
 Weigh baby
 Inject Vit. K, Hepa B and BCG
 Room in and continue exclusive per demand
breastfeeding
After first 90 minutes
 Time band: 90 minutes – 6 hours
 Intervention:Vit. K prophylaxis, Hepa B andf BCG
 Action:
 Wash hands
 Inject Vit. K 1mg IM
 Inject Hepa B and BCG
After first 90 minutes
 Intervention: examine the baby
 Action:
 Thoroughly examine the baby
 Weigh the baby and record
After first 90 minutes
 Intervention: check for birth injuries, malformations or
defects
 Bumps on one or both sides of the head, bruises, swellling on
buttocks, abnormal position of legs after breech presentation
or asymmetrical arm movement, or arm that does not move
 If present: explain to parents that this does not hurt the baby, is likely
to disappear in 1-2 weeks and does not need special treatment
 Gently handle the limb that is not moving
 Do not force legs into a different position
 Look for malformations: cleft palate or lip, club foot, odd
looking or unusual appearance, open tissue on head, abdomen
or back
 Cover open tissue with sterile gauze before referral
 Refer for special treatment
After first 90 minutes
 Intervention: cord care
 Wash hands
 Put nothing on the stump
 Fold diaper below the stump. Keep cord stump loosely covered
with clean clothes
 If stump is soiled, wash with clean water and soap, then dry
thoroughly with clean cloth
 Explain to mother she should seek care if umbilicus is red or
draining pus
 Teach the mother how to treat local umbilical infection 3x a
day
Home cord care
 Mother should wash hands with clean water and soap
before handling the baby
 Gently wash off pus and crusts with boiled and cooled
water and soap
 Dry the area with clean cloth
 Paint with gentian violet
 Wash hands
 If pus or redness worsens or does not improve in 2 days,
refer urgently to hospital
Schedule of routine visits
 Postnatal visit 1: at 48-72 hours of life
 Postnatal visit 2: 7 days of life
 Immunization visit 1: at 6 weeks of life
 Schedule additional follow-up visits depending on baby’s
problems:
 After 2 days: if with breastfeeding difficulty, LBW in 1st week of
life, red umbilicus, skin infection, eye infection, thrush or other
problems
 After 7 days: if LBW discharged >1 week of age and gaining
weight adequately
 The ENC Protocol
DOH Administrative Order
December 2009
Objectives
 In general, this policy aims to ensure provision of globally-
accepted evidence-based essential newborn care focusing
on the first week of life
 Specifically, it aims to:
 Guide health workers and medical practitioners in providing
evidence-based essential newborn care
 Define the roles and responsibilities of the different DOH
office and other agencies in the implementation of ENC
Scope
 This order shall apply to the whole hierarchy of the DOH
and its attached agencies, other public and private
providers of health care and development partners
implementing the Maternal, Newborn and Child Health
and Nutrition (MNCHN) strategy and to all health
practitioners involved in maternal and newborn care.
Implementing mechanism
 Governance:
 The LGU capacity is envisioned to be operational with
organization of service delivery teams
 Community level: WHT
 Facility level: BEmONC and CEmONC teams
 Financing:
 ENC shall be part of enhanced NSD and MCP packages of
PHIC
 Regulation:
 Integrated in PHIC Benchbook
 Service delivery:
 Integrated in BEmONC training programs
Roles and responsibilities
 LGU:
 Adopt and implement the policy
 Ensure availability of budget support
 Conduct orientation/trainings for private and public health
workers on maternal and newborn care policies including this
protocol
 Monitoring and evaluation
 Development partners:
 Support implementation of maternal and newborn care policies
and activities
 Coordinate and collaborate with DOH and the LGUs in the
conduct of maternal and newborn care practices